Key result
Anemia at discharge, but not admission, was independently associated with increased all-cause mortality (HR 1.30; 95% CI 1.05-1.60; P=0.015) in hospitalized patients with HFrEF.
Why the study?
Does anemia at admission or discharge increase the risk of mortality and heart failure hospitalization in hospitalized patients with HFrEF?
Cohort (n=3,731)
Does anemia at admission or discharge increase the risk of mortality and heart failure hospitalization in hospitalized patients with HFrEF?
Modest anemia at discharge, but not at baseline, is associated with increased all-cause mortality and short-term cardiovascular mortality plus HF hospitalization in patients hospitalized for HFrEF.
May warrant discharge anemia monitoring in HFrEF; leaves open whether correction improves outcomes.
BACKGROUND: Anemia has been associated with worse outcomes in patients with chronic heart failure (HF). We aimed to characterize the clinical profile and postdischarge outcomes of hospitalized HF patients with anemia at admission or discharge. METHODS AND RESULTS: An analysis was performed on 3731 (90%) of 4133 hospitalized HF patients with ejection fraction ≤40% enrolled in the Efficacy of Vasopressin Antagonist in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial with baseline hemoglobin data, comparing the clinical characteristics and outcomes (all-cause mortality and cardiovascular mortality or HF hospitalization) of patients with and without anemia (hemoglobin <12 g/dL for women and <13 g/dL for men) on admission or discharge/day 7. Overall, 1277 patients (34%) were anemic at baseline, which persisted through discharge in 73% and resolved in 27%; 6% of patients without baseline anemia developed anemia by discharge or day 7. Patients with anemia were older, with lower blood pressure, and higher creatinine and natriuretic peptide levels compared with those without anemia (all P<0.05). After risk adjustment, anemia at discharge, but not admission, was independently associated with increased all-cause mortality (hazard ratio, 1.30; 95% confidence interval, 1.05-1.60; P=0.015; and hazard ratio, 0.94; 95% confidence interval, 0.76-1.15; P=0.53, respectively) and cardiovascular mortality plus HF hospitalization early postdischarge (≤100 days; hazard ratio 1.73; 95% confidence interval, 1.37-2.18; P<0.001; and hazard ratio, 0.92; 95% confidence interval, 0.73-1.16; P=0.47, respectively). Neither baseline nor discharge anemia was associated with long-term cardiovascular mortality plus HF hospitalization (>100 days) on adjusted analysis (both P>0.1). CONCLUSIONS: Among hospitalized HF patients with reduced ejection fraction, modest anemia at discharge but not baseline was associated with increased all-cause mortality and short-term cardiovascular mortality plus HF hospitalization. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00071331.
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Mentz et al. (2014) conducted a cohort in Heart failure with reduced ejection fraction (n=3,731). Anemia at discharge vs. No anemia at discharge was evaluated on All-cause mortality (HR 1.30, 95% CI 1.05-1.60, p=0.015). Anemia at discharge, but not admission, was independently associated with increased all-cause mortality (HR 1.30; 95% CI 1.05-1.60; P=0.015) in hospitalized patients with HFrEF.
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